NURSING CARE OF A

FAMILY WITH A
NEWBORN
NUTRITIONAL NEEDS
OF A NEWBORN
NUTRITION
• Nutrition: combination of processes by which
organisms receives and utilizes materials or
substances.
• Nutrient: chemical component needed by the
body to provide energy, to build and repair
body tissues and to regulate life processes
• Water, Protein, Carbohydrates, Fats,
Minerals and Vitamins
NUTRITION
• Food: any substance which when ingested by
the body provide nutrient for growth and
maintenance of life.
• Metabolism: process where the body utilizes
food and nutrients.
• Nutritional status: condition or status of the
body resulting from utilization of nutrients.
NUTRITION
• Minimum daily requirement: least amount
of nutrient needed by the person to attain
good health

• Recommended daily allowance: minimum

daily requirement plus additional amount for
consideration to individual’s variation.
Fluids
• Infants need more water than adults
• Infants consume water equivalent to 10-15% of
body weight
• Important functions
• Transport substances
• Solvent for solutes
• Regulate body temperature
• Maintains blood plasma volume
• Digestion of food
• Medium for excretion of wastes
Fluids
• Deficiency:
• Dehydration: water loss beyond
10% body water
• Excess:
• Overhydration: PO or IV intake
Calories
• It is the energy content of food
• Sources: Carbohydrates, Fats, and Protein
• Physiological fuel values of food
• 1 g protein = 4 calories
• 1 g carbohydrates = 4 calories
• 1 g fat = 9 calories
• Average caloric requirement:
100-120 kcal/kg
Calories
• Calorie Deficiency
• Stunted growth
• Loss of weight
• Calorie Excess
• Obesity
Protein
• Repairs and builds body tissues
• Component of enzymes, hormones and
antibodies
• First 6 months: 2.2 g/kg
• 6 months onward: 2 g/kg
• Human milk has 1.2 g/100 mL of
protein while cow’s milk has 3x more
Protein
• Sources
• Milk and milk products, meat, fish, egg,
peanut butter, beans
• Deficiency
• Kwashiorkor
• Impaired immune response
• Excess
• Obesity
Fats
• Important functions
• Energy source
• Carrier of fat-soluble vitamins
• Low fat milk should not be gin to infants.
• Sources: butter, margarine, nuts, milk
and milk products, animal fat, cooking oil
Fats
• Deficiency
• Eczematous skin lesions
• Retarded growth
• Excess
• Obesity
Carbohydrates
• Functions
• Energy source
• Storage form of energy (glycogen)
• Fiber in complex carbohydrates provide
bulk in the diet
• Sources
• Rice, milk, starchy food, sugar, fruits
Carbohydrates
• Deficiency
• Marasmus
• Retarded growth
• Impaired cognitive development
• Hypoglycemia
• Excess
• Obesity
 CHEMICAL SOLUBILI
VITAMIN DEFICIENCY OVERDOSE SOURCES
NAME TY
Beriberi, Wernicke- Drowsiness or muscle Pork, oatmeal, brown rice, vegetables,
Vitamin B1 Thiamine Water

Water-Soluble Vitamins
Korsakoff syndrome relaxation with large doses potatoes, liver, eggs
Dairy products, bananas, popcorn,
Vitamin B2 Riboflavin Water Ariboflavinosis
green beans, asparagus
Liver damage (doses > Meat, fish, eggs, many vegetables,
Vitamin B3 Niacin Water Pellagra
2g/day) and other problems mushrooms, tree nuts
Diarrhea; possibly nausea
Vitamin B5 Pantothenic acid Water Paresthesia Meat, broccoli, avocados
and heartburn
Impairment
Anemia[27]peripheral ofproprioception, nerve
Vitamin B6 Pyridoxine Water Meat, vegetables, tree nuts, bananas
neuropathy. damage (doses >
100 mg/day)
Raw egg yolk, liver, peanuts, certain
Vitamin B7 Biotin Water Dermatitis,enteritis
vegetables
Megaloblast and
Deficiency during May mask symptoms of
Leafy vegetables, pasta, bread, cereal,
Vitamin B9 Folic acid Water pregnancy is associated vitamin B12
liver
withbirth defects, such deficiency; other effects
as neural tube defects
Acne-like rash [causality is
Vitamin B12 Cyanocobalamin Water Megaloblastic anemia Meat and other animal products
not conclusively established]
Vitamin C Ascorbic acid Water Scurvy Vitamin C megadosage Many fruits and vegetables, liver
VITAMIN CHEMICAL NAME SOLUBILITY DEFICIENCY OVERDOSE SOURCES

Fat-Soluble Vitamins Orange, ripe yellow

Night-blindness, fruits, leafy
Vitamin A Retinol Fat Hyperkeratosis, and Hypervitaminosis A vegetables, carrots,
Keratomalacia pumpkin, squash,
spinach, liver

Rickets and Fish, eggs, liver,

Vitamin D Cholecalciferol Fat Hypervitaminosis D
Osteomalacia mushrooms

Deficiency is very rare; Increased congestive heart

Many fruits and
Vitamin E Tocopherol Fat mild hemolytic anemia failure seen in one large
vegetables
in newborn infants randomized study

Leafy green
Increases coagulation in vegetables such as
Vitamin K Menadione Fat Bleeding diathesis
patients taking warfarin spinach, egg yolks,
liver
Minerals
• Iron
• Human milk is poor source of iron despite
maternal supplementation
• Maternal iron stores deplete by 4-6 months
• Low birth weight and premature infants
have limited iron stores
• Needed iron be supplied by diet or
supplementation
Minerals
• Calcium and Phosphorus
• Calcium and phosphorus should be
increased during infancy .
• Calcium content in milk is fairly constant
throughout the lactation .
• Calcium requirement met by infant if
exclusive breastfeeding is done for the first 6
months
Methods of Feeding the Infant

• Breastfeeding
• Breastfeeding directly from the breast
• Done only through mother’s breast
• Done exclusively or supplemented with
bottle feedings
• Involves major commitment
Methods of Feeding the Infant

• Feeding baby expressed breast milk

• Through a bottle given by mother or
another person
• Regular pumping of milk from the breast
• Appropriate handling and storage of milk
• Appropriate preparation of bottles and
nipples
Methods of Feeding the Infant

• Artificial feeding, bottle feeding or

formula feeding
• Use of bottles
• Use of commercially-prepared
formula
Methods of Feeding the Infant

• Mixed feeding
• When baby receives both breastfeeding and
bottle feeding
• May cause nipple confusion
• Supplemental: bottle is substituted for BF
• Complemental: bottle is given after BF to
complete feeding
Feeding Schedule
• Scheduled feedings
• Scheduled intervals of 2-4 hours
• Demand feedings
• Feeding whenever the infant signals
readiness or desires to be nurse
• Breastfed infants: every 1.5-3 hours
• Formula-fed infants: every 3-4 hours
Breastmilk Production

• Types of breast milk

• Colostrum – thick and yellowish; 1st 5 days;
higher protein and high antibodies
• Transitional milk – 6th-14th day;
combination of mature milk and colostrum
• Mature milk – thinner than colostrum but
has more nutrients
Breastmilk Production
• Types of breast milk
• Preterm milk – higher protein, sodium,
iron, immunoglobulins
• Fore milk – produced at start of feed; rich
in minerals, sugar, proteins, vitamins, and
water to quench thirst
• Hind milk – end of feed; higher fat and
energy content to satisfy hunger of infant
Advantages of Breastfeeding
• Nutritional benefits
• Designed to meet the needs of the human infant
• Meets nutritional needs, easily digested and
absorbed
• Nutrient content changes according to needs
of infant
• Caloric content same as in cow’s milk but has
more essential fatty acids
• Has higher carbohydrate content than cow’s
milk
Advantages of Breastfeeding

• Nutritional benefits
• Human milk does not cause allergy
• Has less calcium (to not overwhelm the
kidneys) but still sufficient for infant
• Iron is better absorbed
• More vitamins
Advantages of Breastfeeding
• Dental development
• Due to effort in sucking, favoring jaw and teeth
development
• Bonding
• Close contact of mother and infant
• Immunologic benefits
• Has lactobacillus acidophillus that prevents that
prevents diarrhea
• Has high antibodies
Advantages of Breastfeeding

• Contraceptive effect
• Lactational amenorrhea

• Beneficial to mother’s figure

• Hastens return to prepregnancy weight
• Hastens involution
Continuing Breastfeeding
• Help mother to plan regular feeding schedule
and plan to express her milk a month before
• When she will perform breast pumping (usually 2-4
times per day)
• Schedule should mimic child’s feeding schedule to
ensure continuous supply
• May use bottle feeding if missed breast milk
pumping but only very rarely
• Continue BF when at home
Bottle Feeding

• Infant formulas: 20 kcal/30 mL

• Specific types of formulas
• Standard milk-based formula: cow’s milk + others
• Soy protein formula: for lactose-intolerant
• Formula for premature infants: increase growth
• Formula for infants with metabolic problems: for
those congenital deficiency of certain enzymes that do
not enable them to digest and absorb human or cow’s
milk
Bottle Feeding

• Advantages
• Others can help in feeding
• Mother can sleep through the night
and is able to perform other activities
without being limited
Bottle Feeding

• Disadvantages
• Formula preparation and cleanup time
• Improper mixing may cause GI distress
• Use of wrong type of formula may exacerbate
infant condition
• Costs of formula and bottles
• Emotional conflict for mothers over breastfeeding:
guilt of depriving baby and self
Signs of Well-Fed Baby

• Steady weight gain of 150-240 g per

week
• Normal growth and development pattern
• Happy, active and contented when awake
• Regular and undisturbed sleep
• Has normal bowel movements and
elimination
Introduction of Solid Food
• Indicators of readiness for solid food
• Infants are developmentally ready
• They balance their head well
• Can sit alone
• Can turn away from food they dislike or when
they are already full
• Teeth eruption has begun to facilitate chewing
and biting
Introduction of Solid Food

• Infants are physiologically ready to eat solid

food
• Extrusion reflex has disappeared
• Infant shows readiness to chew when
objects are brought to mouth
• Swallowing without choking
Introduction of Solid Food
• Sequence of introduction of solid food
• Cereals
• Fruits and vegetables
• Meat
• Fish
• Egg yolk and cheese without high sodium
content
• Desserts and sweets
Introduction of Solid Food
• Four months
• Carbohydrates
• Commercially-prepared cereals with rice, oatmeal
or barley but not wheat (allergenic)
• Thin lugao
• Mashed or pureed fruits such as banana, apples,
pears, peaches
• Mashed or pureed vegetables
Introduction of Solid Food

• Five to six months

• Meat can be poached, boiled, broiled, steamed or
baked but not fried; remove fat
• After cooking, meat is pureed in blender
• Fruit juice is started when baby can drink in a
cup
Introduction of Solid Food

• Seven to eight months

• Meats, fish, vegetables and fruits are
chopped finely to teach mastication
• Soft cooked egg yolk with rice porridge,
boiled monggo, boiled fish
Introduction of Solid Food
• Nine to twelve months
• Food are chopped coarsely; whole tender food
may also be given
• Chewy and finger food
• One year
• May eat table food
• Three large meals with in-between feedings